Quantitation of right-to-left shunting by double indicator and oxygen techniques

1976 ◽  
Vol 41 (3) ◽  
pp. 409-415 ◽  
Author(s):  
D. P. Copley ◽  
R. A. Klocke ◽  
F. J. Klocke
Keyword(s):  
Cardiac Output ◽  
Sulfur Hexafluoride ◽  
Venous Return ◽  
Right Heart ◽  
Indocyanine Green Dye ◽  
Arterial Blood ◽  
Vascular Space ◽  
Systemic Venous Return ◽  
Low Solubility ◽  
Right Heart Bypass

An improved double indicator technique for quantitating right-to-left shunting has been validated in a canine right-heart bypass shunt model and compared to standard O2 shunt measurements in the same preparation. A bolus of dissolved sulfur hexafluoride (SF6) and indocyanine green dye (ICG) is injected into systemic venous return and a single, time-averaged arterial blood sample is collected during the initial circulation of indicators. Because of its low solubility, SF6 is eliminated essentially quantitatively from blood traversing gas-filled alveoli; correction for volatile tracer in arterial blood derived from nonshunt pathways in therefore unnecessary. ICG remains confined to the vascular space and SF6 is not lost in shunt pathways. Ratios of SF6-ICG shunt to directly measured shunt averaged 0.99 +/- 0.27 (SD) in 55 comparisons of shunts ranging from 2 to 25% of cardiac output; differences between actual and measured shunt averaged 0.5 +/- 2.9% of cardiac output. Simultaneously determined ratios of O2 shunt to directly measured shunt averaged 0.98 +/- 0.48 in 34 comparisons; differences between actual and measured shunt were 0.7 +/- 3.4% of cardiac output.

Quantitation of anterior descending vs. circumflex venous drainage in the canine great cardiac vein and coronary sinus

1978 ◽  
Vol 234 (2) ◽  
pp. H163-H166 ◽  
Author(s):  
H. K. Nakazawa ◽  
D. L. Roberts ◽  
F. J. Klocke
Keyword(s):  
Indocyanine Green ◽  
Coronary Sinus ◽  
Venous Drainage ◽  
Right Heart ◽  
Great Cardiac Vein ◽  
Indocyanine Green Dye ◽  
Right Heart Bypass ◽  
Heart Bypass

The fractions of left anterior descending (LAD) and circumflex (LC) inflow drainage into the canine great cardiac vein (GCV) and coronary sinus (CS) have been quantitated by use of a right heart bypass preparation in which GCV outflow was isolated from the remainder of CS outflow. Following direct LAD injection of indocyanine green dye (ICG), 63 +/- 8% (SD) of the total amount of dye recovered appeared in GCV outflow and the remainder in CS outflow. CS recovery of ICG was decreased appreciably by ligation of epicardial venous connections between the LAD and LC beds, but was not affected by selective reductions of LAD or LC inflow. Only 3 +/- 3% of ICG injected into the LC was recovered in GVC outflow under basal conditions, and these low values were not affected measurably by selective reductions of LAD or LC inflow. CS drainage of LAD inflow could be augmented by selective increments of GCV pressure exceeding 7-10 mmHg. Increments of LC drainage in GCV outflow required CS pressures that exceeded GCV pressures by greater than 10 mmHg.

A Skeletalized Representation of the Total Cavopulmonary Connection

2007 ◽  
Author(s):  
Resmi Krishnankuttyrema ◽  
Lakshmi Prasad Dasi ◽  
Kerem Pekkan ◽  
Kartik Sundareswaran ◽  
Hiroumi D. Kitajima ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Single Ventricle ◽  
Venous Return ◽  
Right Heart ◽  
Live Births ◽  
Correction Technique ◽  
The Usa ◽  
Systemic Venous Return ◽  
The Right ◽  
Cavopulmonary Connection

Single ventricle congenital heart problems are reported for 2 out of every 1000 live births in the USA. In these cases, mixing of oxygenated and deoxygenated blood occurs in the heart causing severe cyanosis. The Fontan repair is a 3-stage palliative surgical correction technique performed during infancy. Its aim is to restore normal oxygen saturation by directly connecting the systemic venous return to the lungs and bypassing the right heart [1].

Analysis of myocardial and total body integral extraction ratios of rubidium-86

1978 ◽  
Vol 235 (6) ◽  
pp. H794-H802
Author(s):  
P. F. McDonagh ◽  
A. F. Salel ◽  
K. A. Krohn ◽  
E. A. Rhode ◽  
D. T. Mason
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Coronary Blood Flow ◽  
Animal Experiments ◽  
Clinical Use ◽  
Right Heart ◽  
Preliminary Study ◽  
Total Body ◽  
Distribution Of Cardiac Output ◽  
Right Heart Bypass

Coronary blood flow (QM) measurement with radiorubidium (Rb) assumes that Rb distributes to the myocardium in proportion to flow. This assumption is correct if the integral myocardial Rb extraction ratio (ERM) equals total body extraction (ERTB). A right-heart-bypass preparation was employed to test the hypothesis that ERM = ERTB and to examine the determinants of Rb extraction. Dogs were anesthetized with pentobarbital, and arterial, coronary venous, and total body venous Rb concentrations were continuously measured for 4 min after injection. We found that ERM (0.56 +/- 0.01) was significantly less than ERTB (0.70 +/- 0.01), P less than 0.01 (n = 29) and concluded that Rb did not distribute in proportion to flow. We do not recommend this method for clinical use. ERM is flow dependent and ERRB is a function of the total cardiac output and the distribution of cardiac output. Before employing Rb in animal experiments, it is recommended that a preliminary study be performed comparing flow measured with Rb to an independent measure of blood flow.

Letter to the Editor

PEDIATRICS ◽  
1974 ◽  
Vol 53 (2) ◽  
pp. 289-289
Author(s):  
John Kattwinkel ◽  
Avroy A. Fanaroff ◽  
Marshall H. Klaus
Keyword(s):  
Cardiac Output ◽  
Venous Return ◽  
Blood Gases ◽  
Lung Compliance ◽  
Nasal Cpap ◽  
Vascular Space ◽  
Letter To The Editor

Initially, our procedure in instituting nasal CPAP was to start with a pressure of 6 cm H2O and increase gradually as blood gases dictated. Our concern was that in some infants, higher pressures might impede venous return thus compromising cardiac output. However, experience shows that if the technique is reserved for only patients with severe RDS (i.e., PaO2 < 60 mm Hg in FiO2 ≥ 70%) their lung compliance is low and transmission of pressure to the vascular space is probably negligible.

Mechanism of action of isoproterenol on venous return

1977 ◽  
Vol 232 (2) ◽  
pp. H152-H156 ◽  
Author(s):  
J. F. Green
Keyword(s):  
Venous Return ◽  
Venous Pressure ◽  
Portal Pressure ◽  
Vascular Effects ◽  
Right Heart ◽  
Control Value ◽  
Anesthetized Dogs ◽  
Venous Resistance ◽  
Right Heart Bypass ◽  
Transient And Steady State

The systemic vascular effects of isoproterenol infused in a dose of 1 mug-kg-1-min-1 was studied in 10 anesthetized dogs. A right heart bypass preparation allowed the separation of venous return into splanchnic and extrasplanchnic flows. Each channel was drained by gravity into an external reservoir. Venous return was then pumped into the pulmonary artery. During the infusion of isoproterenol, the pump was set at sufficient speed to maintain a constant level of blood in the external reservoir. Venous resistances and compliances of both channels were calculated from transient and steady-state volume shifts that occurred after rapid drops in splanchnic and then extrasplanchnic venous pressures. Isoproterenol affected both arterial and venous systems. Venous return increased from 1.62+/-0.11 to 2.40+/-0.19 liter/min (P less than 0.001) while arterial pressure fell from 97.5+/-3.8 to 70.2+/-5.9 mmHg (P less than 0.01). The compliances of the splanchnic and extrasplanchnic channels did not change significantly from their control values of 0.025+/-0.004 and 0.024+/-0.002 liter/mmHg. The venous resistance of the extrasplanchnic channel also did not change from its control value of 5.0 mmHg-liter-1-min-1; however, the splanchnic venous resistance decreased from 16.3+/-3.2 to 9.4+/-2.8 mmHg-liter-1-min-1 (P less than 0.001). The effective splanchnic back pressure, estimated by measuring the level to which hepatic venous pressure had to be raised to cause a change in portal pressure, decreased from 3.9 to 3.0 mmHg (P less than 0.01).

Noninvasive cardiac output determination using inhaled oxygen-15-labeled carbon dioxide

1982 ◽  
Vol 53 (5) ◽  
pp. 1125-1132 ◽  
Author(s):  
N. M. Braslow ◽  
C. A. Hales ◽  
B. Hoop ◽  
D. J. Kanarek ◽  
H. Kazemi
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Output ◽  
Linear Regression ◽  
Indocyanine Green ◽  
Correlation Coefficient ◽  
Animal Studies ◽  
Noninvasive Technique ◽  
Indocyanine Green Dye ◽  
Arterial Blood ◽  
Carbon Dioxide Co2

Inhaled oxygen-15-labeled carbon dioxide (CO2*) is hydrated in the alveolar capillary blood to produce oxygen-15-labeled water (H2O*). This allows noninvasive delivery of a traceable indicator into the pulmonary circulation. Removal of oxygen-15 marker from the lung is a function of pulmonary perfusion. Two techniques were evaluated for computing cardiac output (CO) following single bolus inhalation of CO2*: 1) continuous monitoring of arterial blood activity through an external detector and 2) noninvasive positron imaging of oxygen-15-label washout from the chest and simultaneous emergence of activity in arterial blood. In seven mongrel dogs studied using technique 1, 46 determinations of CO were made from 1.2 to 8.0 l/min and compared with simultaneous indocyanine green dye-dilution determination. Correlation coefficient was 0.90 with slope of linear regression of 1.05. In 12 mongrel dogs studied using technique 2, 23 determinations of CO were made from 0.9 to 9.2 l/min and compared with simultaneous indocyanine green dye determination. Correlation coefficient was 0.985 (P less than 0.001) with slope of linear regression of 0.898. This noninvasive technique (2) for determination of CO is independent of assumptions regarding regional ventilation or perfusion of the lung and appears valid in animal studies.

scholarly journals Early Findings after Implementation of Veno-Arteriovenous ECMO: A Multicenter European Experience

Membranes ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 81
Author(s):  
Aaron Blandino Ortiz ◽  
Mirko Belliato ◽  
Lars Mikael Broman ◽  
Olivier Lheureux ◽  
Maximilian Valentin Malfertheiner ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Venous Return ◽  
Demographic Data ◽  
Low Cardiac Output Syndrome ◽  
Low Cardiac Output ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Va Ecmo ◽  
Vv Ecmo

Extracorporeal membrane oxygenation (ECMO) is increasingly used to treat cardiopulmonary failure in critically ill patients. Peripheral cannulation may be complicated by a persistent low cardiac output in case of veno-venous cannulation (VV-ECMO) or by differential hypoxia (e.g., lower PaO2 in the upper than in the lower body) in case of veno-arterial cannulation (VA-ECMO) and severe impairment of pulmonary function associated with cardiac recovery. The treatment of such complications remains challenging. We report the early effects of the use of veno-arterial-venous (V-AV) ECMO in this setting. Methods: Retrospective analysis including patients from five different European ECMO centers (January 2013 to December 2016) who required V-AV ECMO. We collected demographic data as well as comorbidities and ECMO characteristics, hemodynamics, and arterial blood gas values before and immediately after (i.e., within 2 h) V-AV implementation. Results: A total of 32 patients (age 53 (interquartiles, IQRs: 31–59) years) were identified: 16 were initially supported with VA-ECMO and 16 with VV-ECMO. The median time to V-AV conversion was 2 (1–5) days. After V-AV implantation, heart rate and norepinephrine dose significantly decreased, while PaO2 and SaO2 significantly increased compared to baseline values. Lactate levels significantly decreased from 3.9 (2.3–7.1) to 2.8 (1.4–4.4) mmol/L (p = 0.048). A significant increase in the overall ECMO blood flow (from 4.5 (3.8–5.0) to 4.9 (4.3–5.9) L/min; p < 0.01) was observed, with 3.0 (2.5–3.2) L/min for the arterial and 2.8 (2.1–3.6) L/min for the venous return flows. Conclusions: In ECMO patients with differential hypoxia or persistently low cardiac output syndrome, V-AV conversion was associated with improvement in some hemodynamic and respiratory parameters. A significant increase in the overall ECMO blood flow was also observed, with similar flow distributed into the arterial and venous return cannulas.

EFFECT OF ENDRIN ON VENOUS RETURN AND CATECHOLAMINE RELEASE IN THE DOG

1966 ◽  
Vol 44 (1) ◽  
pp. 59-67 ◽  
Author(s):  
D. A. Reins ◽  
J. A. Rieger Jr. ◽  
W. B. Stavinoha ◽  
L. B. Hinshaw
Keyword(s):  
Blood Pressure ◽  
Cardiac Output ◽  
Adrenal Glands ◽  
Venous Return ◽  
Lethal Dose ◽  
Peripheral Resistance ◽  
Primary Source ◽  
Arterial Blood ◽  
Total Body ◽  
The Relationship

Previous reports have shown that dogs treated with the insecticide endrin develop marked changes in blood pressure and heart rate accompanied by convulsions terminating in death. The present study was designed to determine the relationship between venous return (cardiac output), total peripheral vascular resistance, and hypertension seen in succinylcholine-treated dogs after a lethal dose of endrin. Experiments were performed on "intact" (viscera intact) and eviscerated dogs under conditions of total body perfusion. Results indicate that the rise in systemic arterial blood pressure depends primarily on increased cardiac output due to an elevated venous return. Total peripheral resistance does not change significantly in either group of animals. The abdominal viscera were the primary source of the increase in venous return after endrin. Adrenal glands were partially depleted of adrenaline, and increased levels of adrenaline and noradrenaline found in blood plasma may explain the marked alterations in systemic hemodynamics.

IN SITU AND PILOT ORGAN PERFUSION TECHNIQUES FOR THE STUDY OF METABOLIC DYNAMICS

1972 ◽  
Vol 68 (2_Supplb) ◽  
pp. S9-S25 ◽  
Author(s):  
John Urquhart ◽  
Nancy Keller
Keyword(s):  
Cardiac Output ◽  
Large Fraction ◽  
Experimental Studies ◽  
Test Substance ◽  
Organ Perfusion ◽  
Systemic Blood ◽  
Experimental Control ◽  
Arterial Blood ◽  
Vascular Connections

ABSTRACT Two techniques for organ perfusion with blood are described which provide a basis for exploring metabolic or endocrine dynamics. The technique of in situ perfusion with autogenous arterial blood is suitable for glands or small organs which receive a small fraction of the animal's cardiac output; thus, test stimulatory or inhibitory substances can be added to the perfusing blood and undergo sufficient dilution in systemic blood after passage through the perfused organ so that recirculation does not compromise experimental control over test substance concentration in the perfusate. Experimental studies with the in situ perfused adrenal are described. The second technique, termed the pilot organ method, is suitable for organs which receive a large fraction of the cardiac output, such as the liver. Vascular connections are made between the circulation of an intact, anaesthetized large (> 30 kg) dog and the liver of a small (< 3 kg) dog. The small dog's liver (pilot liver) is excised and floated in a bath of canine ascites, and its venous effluent is continuously returned to the large dog. Test substances are infused into either the hepatic artery or portal vein of the pilot liver, but the small size of the pilot liver and its blood flow in relation to the large dog minimize recirculation effects. A number of functional parameters of the pilot liver are described.

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